Emergency Course -- A 14-year-old Female with Emesis and Cyanosis

The patient was noted to have a maroon, round tablet with AP1 scored on one side (Fig.1) in the product of emesis.

INITIAL LABORATORY WORK UP:

Test

Reference Range

Result

Urea Nitrogen

(6-18 mg/dl)

8 mg/dl

Creatinine

(0.2-1.1 mg/dl)

0.9 mg/dl

Total Bilirubin

(0.2-1.3 mg/dl)

0.6 mg/dl

Gamma glutamyl transferase

(<44.0 Units/L)

24 U/L

AST

(<40.0 Units/L)

25 U/L

ALT

(<40.0 Units/L)

25 U/L

Alk.Phosphatase

(<400 Units/L)

97 U/L

Carbon Mono

<1%

0.7%

Methehemoglobin

(0.0-3.0%)

25.6%

pH Venous

(7.30-7.40)

7.40

PCO2 Venous

(41-51mm Hg)

41 mm Hg

PO2 Venous

(35-45 mm Hg)

46 mm Hg

HCO3 Venous

(22-26 mm Hg)

25 mm Hg

Base Excess

(0-2 mm Hg)

1 mm Hg

Hgb

(12.0-16.0 mg/dl)

12.8 mg/dl

HCT

(36.0-46.0%)

38.1%

RBC

(4.10-5.20)

4.30

MCV

(78.0-102.0)

88.5

MCH

(24.0-30.0)

29.7

MCHC

(32.0-36.0)

33.6

RDW

(11.8-15.2)

13.1

WBC

(4.5-13.0)

12.5

Neutrophils

(31-61%)

80

Lymphocytes

(28-48%)

13*

Monocytes

(3-9%)

7

Eosinophils

(0-3%)

0

Basophils

(0-2%)

0

Platelets

(156-369%)

31

The patient's urine drug screen for drugs of abuse and Gas Chromotagraphy/Mass Spectroscopy - comprehensive drug screen were negative except for methylene blue and caffeine. (note: pyridium was not included in drug library)